Utilidad en la práctica clínica de la determinación de eosinófilos en el esputo inducido del paciente con asma grave / Usefulness in clinical practice of the determination of eosinophils in the induced sputum of patients with severe asthma

En los últimos años, la determinación demarcadores inflamatorios ha cobrado importancia. Los eosinófilos en el esputo inducido son un ejemplo de ello en el caso del asma grave. Objetivo: Valorar la eosinofilia en esputo como marcador de exacerbaciones, control de la enfermedad y decisión terapéutica. Determinar un punto de corte que indique un peor control del asma. Metodología: Estudio descriptivo prospectivo de serie de casos de asma grave eosinofílico, a los que se le realizó una prueba de esputo inducido, cuantificando el porcentaje de eosinófilos.Resultados: Se estudiaron 59 pacientes, con edad media de 51,55 ± 13,5 años. La mayoría con Índice de Masa Corporal (IMC) > 25. Un 65% fueron mujeres. Respecto a la función pulmonar, lo más frecuente fue la obstrucción moderada y el 68,4% algún biológico. La media de eosinófilos en sangre fue 333,62 ± 475 y en el esputo 7,94 ± 11,43%. Se logró establecer un punto de corte del 4% en el nivel de eosinófilos, relacionado con variables clínicas de control de enfermedad (tandas de corticoides y agudizaciones) para definir peor control (p = 0,013 y 0,033). Fue más significativo en tratados con biológicos. Supuso cambios terapéuticos en el 62,3% y al año una mejora en el ACT de 2,65 puntos. Se estableció correlación entre FeNO y eosinófilos en esputo (coef Pearson -0,280; p = 0,033).Conclusiones: El contaje de eosinófilos en el esputo inducido podría ser un marcador de utilidad en la valoración del control del asma grave eosinofílico y en la toma de decisiones.

In recent years, the determination of inflammatory markers has gained importance.Eosinophils in induced sputum are an example of this in severe asthma. Objetive: Assess sputum eosinophilia as a marker of exacerbations, disease control and therapeutic decision. Determine a cut-off point that indicates worse asthma control. Methodology: Prospective descriptive study of a series of cases of severe eosinophilic asthma, who underwent an induced sputum test, quantifying the percentage of eosinophils. Results: 59 patients were studied, with a mean age of 51.55 ± 13.5 years. The majority had a Body Mass Index (BMI) > 25. 65% were women. Regarding lung function, the most frequent was moderate obstruction and 68.4% some biological. The mean number of eosinophils in blood was 333.62 ± 475 and in sputum 7.94 ± 11.43%. It was possible to establish a cut-off point of 4% in the level of eosinophils, related to clinical variables of disease control (courses of corticosteroids and exacerbations) to define worse control (p = 0.013 and 0.033). It was more significant in those treated with biologicals. It involved therapeutic changes in 62.3% and meant an improvement in the ACT of 2.65 points after one year. A correlation was established between FeNO and sputum eosinophils (Pearson coefficient -0.280; p = 0.033). Conclusions: Eosinophil count in induced sputum could be a useful marker in assessing control of severe eosinophilic asthma and in decision making. (AU)

Hepatocellular carcinoma and liver transplantation: a 12-year experience.

BACKGROUND: Orthotopic liver transplantation (OLT) for patients with cirrhosis and concomitant hepatocellular carcinoma (HCC) in early stages is the treatment of choice, with an acceptable recurrence rate and excellent survival. AIM: We sought to evaluate (1) the accuracy of preoperative imaging; (2) the impact of pre-OLT treatments on survival and recurrence; and (3) the influence of beyond Milan criteria selection on global outcomes. METHODS: We studied a cohort of 65 patients with HCC among 300 consecutive OLTs over a single 12-year experience. We analyzed the overall outcomes of survival and recurrence, the accuracy of preoperative diagnosis and staging the influence of neoadjuvant treatment prior to OLT, and the effect on overall outcomes beyond the Milan criteria in our series. RESULTS: The 65 transplants were performed for HCC, mostly in association with hepatitis C virus and alcoholic cirrhosis with HTP. At a mean follow-up of 40.32 months, the recurrence rate was 5.7% among the 61 HCC confirmed by histopathology. The overall survival was 30.07. Actuarial survivals at 1, 5, and 10 years were 82%, 77%, and 62%, respectively. Six retransplants occurred among the seven graft losses albeit with poor survival after the second graft. Most explants showed low pTNM stages with favorable microscopic features. Preoperative imaging tests failed to achieve an accurate diagnosis in 15.38% of the series. The role of alpha-fetoprotein (AFP) and hepatic biopsy was irrelevant. Unfavorable histopathologic factors predicted a greater recurrence rate, but had no influence on survival. Neither recurrence nor survival were modified by pre-OLT therapy. CONCLUSIONS: In our series, AFP, hepatic biopsy, and pre-OLT treatment had limited roles. Radiological imaging techniques underestimated HCC staging and lead to a misdiagnosis to an expected degree. Despite these findings, this single institution experience with OLT for HCC showed excellent survivals with a low recurrence rate including cases of patients beyond the Milan criteria.